1. OB/GYN Review Course: STD Questions Peter G. Gulick, DO, FACP, FACOI Associate Professor

2. 1. Which screening test is not recommended in a pregnant woman? a. HIV test b. Chlamydia trachomatis c. Serological test for syphilis d. Neisseria gonorrhoeae e. Hepatitis B and C f. HSV 1 and 2 testing

3. 2. Is this a true or false statement? A pregnant patient who tested HIV negative at initial visit and who admits to having sexual activities during pregnancy should be retested in the 3 rd trimester. A pregnant patient who tested HIV negative at initial visit and who admits to having sexual activities during pregnancy should be retested in the 3 rd trimester. a. True b. False

4. 3. A pregnant patient tests HIV positive. Which statement is true? a. Average risks of fetal transmission is 55%. b. HAART treatment reduces transmission to 10%. c. The test has a 30% chance of being false positive. d. Patient should be placed on HAART therapy. e. C-section is still advised even with undetectable viral load.

5. 4. Choose the true statement. a. In sexually active women, who are Hepatitis B negative, repeat testing for each pregnancy is not necessary. b. Pregnant Hepatitis C women require gamma immune globulin at time of delivery. c. C-section is required for all Hepatitis C women with active Hepatitis C. d. A patient previously vaccinated should not be tested for Hepatitis B at pregnancy. e. Hepatitis C positive patients should not be treated with interferon/ribavirin if pregnant or contemplating pregnancy.

6. 5. Which statement is true regarding chancroid? a. The genital ulcers and adenopathy are usually painless. b. Coinfection with T palladium or HSV is never seen c. Use of H. ducreyi PCR testing is 90% sensitive but not FDA approved d. Erythomycin 1 gm po x 1 day is preferred. e. A single HIV test at initial diagnosis of chancroid is sufficient if negative.

7. 6. Which statement is true regarding genital herpes testing? a. IgM test positive indicates primary infection. b. HSV PCR testing of lesions is 3 to 4 times more sensitive than cultures. c. HSV positive serology indicates active infection. d. HSV glycoprotein testing does not differentiate between HSV 1 and 2. e. Cytologic detection (a Tzank prep) of active genital ulcers is both sensitive and specific.

8. 7. Which statement is true regarding HSV 1 and 2 genital infections? a. HSV 1 and 2 behave the same in causing genital infections. b. HSV 1 tends to have fewer genital recurrences than HSV 2. c. HSV 1 tends to cause less severe infections in the fetus than HSV 2 in primary infections in pregnancy. d. The rate of genital infection with HSV 1 is less than 10%. e. HSV 1 tends to be more resistant to Acyclovir than HSV 2.

9. 8. Which statement is true regarding genital herpes in pregnancy? a. Risk of transmission is 80% if acquired primary in 3 rd trimester. b. Risk of transmission is 20% if had recurrence in pregnancy. c. Patients who are HSV 2 positive serologically still require C-section even with no clinical genital lesions. d. Acyclovir treatment in late pregnancy reduces C-section in pregnancy. e. Valcyclovir has been proven to be teratogenic in pregnant females.

10. 9. True statements concerning lymphogranuloma venerium include all of the following except: a. Tender large unilateral inguinal adenopathy with painless genital ulcer. b. Diagnosis is with complement fixation titre > 1:64.with appropriate clinical presentation c. Pregnant women should be treated with erythromycin. d. Therapy is with Doxycycline 100 mg bid x 7 days. e. Chronically these lesions may develop into strictures and fistulas.

11. 10. Which statement regarding diagnostic testing for syphilis is false? a. Darkfield exam and direct fluorescent Ab tests are definitive methods. b. Non treponomal tests correlate with disease activity. c. People with reactive treponomal tests will maintain them for life. d. One can also use reactive treponomal tests as markers of response to therapy. e. When using VDRL and RPR to test an individual’s response to treatment, one cannot use them interchangeably.

12. 11. All of the statements regarding syphilis are true except: a. Primary infection results in a painless genital ulcer or chancre. b. Secondary infection includes skin rash, mucocutaneous lesions. c. Tertiary infection involves cardiac or ophthalmic manifestations. d. Latent syphilis is usually seen within prior year and is asymptomatic. e. The therapy for all forms of syphilis is the same.

13. 12. All of the statements are true regarding syphilis in pregnancy except: a. Reactive treponomal testing needs non treponomal testing to detect activity. b. Serological testing should be repeated in 3 rd trimester in high activity risk. c. Patients with penicillin allergies may be treated with erythromycin. d. The Jarish Heximeyer reaction may precipitate premature labor. e. Some settings of 1° or 2° syphilis require 2 doses of penicillin.

14. 13. Which statement is true regarding therapy of syphilis in pregnant patients? a. There are no alternatives to penicillin. b. Erythromycin can be used if the patient is allergic to penicillin. c. Ceftriaxone can be used if the patient is allergic to penicillin. d. Therapy should be delayed until the 3 rd trimester. e. The baby should be given prophylactic therapy at birth.

15. 14. All of the statements regarding congenital syphilis are true except: a. IgM testing should be done on infants. b. Infant serum blood should be tested versus cord blood. c. Compare maternal and infant nontreponomal serological titres by using the same test. d. Routine screening of newborn sera or cord blood is not recommended. e. Treatment of infant based on adequacy of maternal treatments.

16. 15. Which Statement regarding cervicitis is false? a. C Trach and GC cause the majority of cases. b. Leukocytes (>10 WBC in vaginal fluid) in the absence of trichomonas may indicate cervicitis. c. Other causes of cervicitis include bacterial vaginosis, M. Genitalium infection and douching. d. A majority of cases of persistent cervicitis despite therapy are not caused by C trachomatis, and GC. e. M. Genitalium is not a definite pathogen in cervicitis.

17. 16. True statements regarding Chlamydia infection in pregnancy include all of the following except: a. Doxycycline, levofloxacin and floxacin are contraindicated. b. Azithromycin is safe and effective. c. Repeat testing after therapy is completed is not necessary. d. Erythromycin estalate is contraindicated due to hepatotoxicity. e. Erythromycin base has a lot of GI side effects.

18. 17. A patient presents with persistent gonococcal infection despite treatment. What test should be preformed? a. Nucleic acid hybridization tests. b. Gram stain of genital secretions. c. Cultures of genital secretions. d. Cultures and antimicrobial sensitivity of secretions. e. PCR testing.

19. 18. Which statement is true regarding quinolone resistant gonococcus? a. New York has the highest prevalence in the U.S. b. In cipro resistant cases, Levofloxin can be used. c. QRGC is seen more in MSM than heterosexuals. d. CDC surveillance project found 30% of U.S. isolates were resistant in 2004. e. Quinolone resistant GC is rarely seen outside the U.S.

20. 19. True statements regarding bacterial vaginosis (BV) include all of the following except: a. See presence of clue cells on microscopic exam. b. Fishy odor occurs after adding 10% KOH to discharge. c. BV during pregnancy can have adverse outcomes. d. Treatment of male sexual partners should always be done. e. Recommended therapy in pregnancy is metronidazole 500mg for 7 days

21. 20. Which statement is correct regarding BV and pregnancy? a. All women with asymptomatic BV require therapy. b. BV has been associated with adverse outcomes in pregnancy. c. Metronidozole is contraindicated in BV pregnancy. d. Intravaginal Cleocin is very effective in pregnancy. e. BV usually presents with thick greenish discharge during pregnancy.

22. 21. Patients with PID may present with all of the following except: a. Fevers of > 101°F. b. Cervical motion tenderness. c. Elevated sed rate and CRP. d. Abundant WBC in vaginal secretions. e. Severe flank pain with percussion.

23. 22. All of the following are indications for hospitalization of patients with PID except: a. Patient with high fever and severe nausea, vomiting. b. Patient is pregnant. c. Patient has a suspected tubo-ovarian abscess. d. Patient with a WBC of 15,000 with fever. e. Patient not responding clinically to oral therapy.

24. 23. Which statement is true regarding Human Papilloma Virus (HPV) infections? a. HPV types 6 and 11 are mainly oncogenic strains. b. HPV types 16, 18, 33 and 35 mainly cause genital warts. c. A definitive diagnosis for HPV requires serological testing d. Genital HPV usually presents as warts. e. Acetic acid testing for HPV is very specific.

25. 24. All of the statements regarding therapy of HPV are true except: a. The HPV vaccine is still effective even if you have genital warts b. Untreated genital warts may resolve on their own. c. Patients infected with genital warts usually have only one HPV. d. In pregnancy, podophyllin therapy should not be given

26. 25. All statements regarding HPV and pregnancy are true except: a. Imiquimod and Podophyllin should not be used in pregnancy. b. HPV types 6 and 11 can cause respiratory papillomatosis in infants. c. C-section should always be considered as a way to prevent transmission to newborns. d. Route of transmission to newborn is not understood. e. No specific HPV types are seen in pregnancy.